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The road ahead for 2018

December 8, 2017

BY DR ROD McRAE, CHAIR, AMA COUNCIL OF PUBLIC HOSPITAL DOCTORS

Another calendar year has flown. CPHD meets regularly to make sure AMA’s positions are informed by those with a Specialist qualification and choosing to self-identify as public hospital doctors. This embraces the Specialist employed experience and the continuing quest for continuous public hospital medical quality and general systems improvement. We have an influencing position that is enhanced by more members taking opportunity to solidify CPHD’s base and keep us rich with progressive ideas. Industrial negotiations for employed medical practitioners are currently underway in several jurisdictions, many of which have been impacted by the federal government’s alteration of previously understood arrangements related to salary packaging. It will be of acute interest to observe how these negotiations are managed, as most have mandated elections from the time of my writing to October 2018.

COAG – Public Hospital funding Agreement

In July 2017, the States and Commonwealth executed a health care funding Agreement out to 2020. It laudably touts incentives aimed to reduce avoidable sentinel events, hospital acquired complications and avoidable readmissions. However, if a State does not achieve an arbitrary benchmark, the otherwise locked in 45 per cent of their public hospital funding could be at risk (including a slice of an additional $2.9 billion of capped services growth funding).

There becomes a risk that any public hospital not adequately meeting its risk improvement targets, irrespective of cause, will then bear funding cuts, yet still be required to meet the defined Agreement imperatives (thus a potentially downward spiral of ‘doing more with less’). Such a hospital would be incentivised to rapidly make change in the hope of reducing its funding loss. Public hospitals may insist members work unsociable hours (for alleged quality & efficiency reasons), roll-out an unmanaged expansion of private practice arrangements (to cover funding shortfalls) and redirect Doctor’s clinical support time to the design of new systems (all to avoid the penalties). CPHD will work on these and a host other concerns that require our reasoned and measured response. In 2018, CPHD will monitor against such potentially perverse outcomes that may arise from the underpinning by an ultimately penalty-based regime, let alone the potential for cherry-picking.

Private Practice

For this health care funding agreement round, the Commonwealth seems to have flagged its willingness to consider change to the arrangements applying to private patients admitted to public hospitals. As discussed in October, there are good reasons why CPHD is concerned about any attempt to substantially reform existing arrangements, including availability of specialist clinical skills & equipment, supplementation of public hospital income and breadth of case mix available for optimum teaching, training and research.

CPHD recognises and supports the long-standing rights of public hospital patients who elect to receive services as a private patient, but appreciates there does need to be balance. It is a no-brainer that clinical need, not private/public status, must be the determinant for patient prioritisation and that the patient must be free to make informed choice without unfair inducements or undue pressure to convert to private insurance. Equally, Doctors must be assured of their right to provide care without undue pressure to encourage conversion from public status. CPHD will be at the vanguard of any mooted change agenda.

Personal Safety

In my August Australian Medicine piece I expressed how I am regularly horrified at the experiences of violence in our community and our workplaces. Therefore, CPHD motives are obvious in its lead advocacy for better investment in security, awareness, technology and facilities to make all employees safe when at work. It seems to me our response should be health professional holistic rather than just doctor specific (i.e. protecting the team). We still want accessible and personable care for the public so excessive responses are to be avoided (think armed security in Victorian emergency departments previously batted off by AMA because the idea presented more dangers than it solved). CPHD will produce an AMA position to reduce workplace dangers in light of escalating population growth, mental health / substance abuse presentations and the anger born amongst some from frustrations at the lack of public hospital responsiveness and capacity.

Overall, your Council of Public Hospital Doctors is in the business of emerging trend identification and response. No doubt in 2018 some ‘curly’ policy pronouncement will emerge from government ranks but we are consultative, responsive and equipped to ensure our public patients and our public employed clinical ranks are protected from the excess of public service thought bubbles or political ideology.

I offer season’s greetings to all of our AMA membership family. It is important for all to ensure they have a sensible break and attend to personal well-being, family and friends, and to start 2018 refreshed and invigorated. See you in the New Year!